Patient Cost Estimation Specialist I

Nemours is seeking a Patient Cost Estimation Specialist to join our team remotely.

The Patient Cost Estimation Specialist reports to the manager of the Cost Estimation Team. The Specialist utilizes high-level customer service, healthcare finance and revenue cycle knowledge, and excellent communication skills. The Specialist has a detailed understanding of price transparency regulations, including but not limited to the No Surprises Act of 2020, and how it relates to challenges in a complex health care environment. This person is the primary contact for patient-families and colleagues seeking to understand financial care of services to be delivered.

The Patient Cost Estimation Specialist works closely with authorization, financial advocate, clinical representatives, and business stakeholders in order to most accurately provide estimated cost for patient-families. This person has extensive knowledge of patient benefit design and care delivered by Nemours in order to effectively help a patient-family understand how it relates to their scheduled procedure or service. They do this in a way that upholds a patient-centered model of care delivery and Nemours’ values and standards of behavior.

Essential Functions:

1. Identify how an individual’s planned service will relate to their specific payor and plan design, including but not limited to tiers and benefit levels.

2. Based on historical data, patient-specific information, and authorizations, identify the appropriate CPTs for which to estimate.

3. Deliver and communicate the patient cost estimate to both patient-families and providers, as applicable.

4. Discuss financial options with families. Collect pre-payments from patient-families.

5. Meet all regulations in regard to the No Surprises Act.

Builds and maintains effective enterprise-wide relationships with clinical team members, business operations, various department representatives, authorization specialists, financial advocates, and other stakeholders, as applicable.

Requirements:

• High school Diploma required

• Certified Revenue Cycle Representative (CRCR) required within first 12 months

• Minimum of 3 years experience required

• Healthcare experience required

Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware and Nemours Children’s Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we’re on a journey to discover better ways of approaching children’s health. Putting as much focus on prevention as cures and working hand in hand with the community to make every child’s world a place to thrive. It’s a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All of our associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

To learn more about Nemours Children’s and how we go well beyond medicine, visit us at www.nemours.org.